腰椎压缩性骨折行PVP术后再骨折人群的影像学特征分析

Analysis of imaging characteristics of re-fractures after percutaneous vertebroplasty for lumbar vertebral compression fractures

目的分析腰椎压缩性骨折行经皮椎体成形术(PVP)后再骨折危险因素以及影像学特征。方法选择骨科2018年8月至2022年8月接受PVP手术治疗的腰椎压缩性骨折患者216例,根据PVP术后是否发生再骨折分组,将52例再骨折患者设为观察组,164例未发生再骨折的患者设为对照组,统计患者基本信息、临床特征、影像学参数、术后其他并发症等,单因素、多因素Logistic回归分析PVP术后腰椎再骨折的危险因素。结果观察组性别、合并基础病、年龄、体重指数(BMI)、骨水泥注入量、骨水泥注入方式、伤椎椎体恢复高度、并发症与对照组比较,差异无统计学意义(P>0.05);观察组既往椎体骨折病史、骨密度、伤椎数、Cobb角、骨水泥渗漏与对照组比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,既往椎体骨折病史、骨密度、伤椎数、Cobb角、骨水泥渗漏是PVP术后腰椎再骨折的危险因素(P<0.05)。结论PVP术后腰椎再骨折的风险仍旧较高,影像学特征以Cobb角增高为主,既往椎体骨折病史、骨密度降低、伤椎数多、Cobb角增加、骨水泥渗漏均是诱发腰椎再骨折的危险因素,临床应针对以上危险因素,及早给予针对性处理,最大限度降低腰椎再骨折发生率。

Objective To analyze the risk factors and imaging characteristics of re-fractures after percutaneous vertebroplasty(PVP)for lumbar compression fractures.Methods A total of 216 patients with lumbar vertebral compression fractures surgically treated with PVP from August 2018 to August 2022 in the Department of Orthopedics of our hospital were recruited.Classified by the re-fractures after PVP or not,re-fracture patients(n=52)were included in the observation group,and patients without re-fractures(n=164)were included in the control group.Baseline characteristics,clinical characteristics,imaging parameters,and other postoperative complications of the patients were compared.Univariate and multivariate Logistic regression analyses were performed to identify risk factors for re-fractures after PVP for lumbar spine refractures.Results There were no significant differences in the gender,underlying diseases,age,body mass index(BMI),bone cement injection amount,bone cement injection method,vertebral body recovery height and the incidence of complications between control group and observation group(P>0.05).Significant differences in the history of vertebral fracture,bone mineral density,number of injured vertebrae,Cobb angle and bone cement leakage were detected between groups(P<0.05).Logistic regression analysis showed that the history of vertebral fracture,bone mineral density,number of injured vertebrae,Cobb angle,and bone cement leakage were the risk factors for refractures after PVP for lumbar fracturess(P<0.05).Conclusion The risk of lumbar spine refracture after PVP is still high,with the main imaging feature of the increased Cobb angle.History of vertebral body fracture,decreased bone mineral density,more injured vertebrae,increased Cobb angle,and bone cement leakage are risk factors for refractures after PVP for lumbar fractures.Intime targeted approaches for these risk factors are urgently needed to minimize the incidence of lumbar refractures.